Diluting Sandimmun - help!

Re: Diluting Sandimmun - help!

Stephen Courtney — Sat, 17 Nov 2012 20:48:06 GMT

Make it up straight. why ever not?

Tacrolimus does the same job, use the stronger of the two Protopic ointments. You squeeze a small amount out onto a cotton bud, and try and roll a little onto the inside of the upper lid with the cotton bud. Apparently really easy to do and doesn't sting or irritate.The tube lasts ages and ages and is really good value for these cases, and again, the diplomate who told me this said there was no need to worry about tossing the tube every 28 days

There are some H&S concerns with handling any of these products but normal care is all that is required.

BTW i use the 2% Ciclosporin drops for recalcitrant KCS (IE follow the cascade) and also for severe pannus.

Re: Diluting Sandimmun - help!

David Mills — Sat, 17 Nov 2012 17:58:24 GMT

A place I used to work used to make up half, leave it overnight and then top it up - is there any thinking behind this or do people just make it up straight?

Re: Diluting Sandimmun - help!

Glenn Hodgson — Sat, 17 Nov 2012 16:03:35 GMT

do others use tacrolimus much?

Re: Diluting Sandimmun - help!

Stephen Courtney — Sat, 17 Nov 2012 15:21:32 GMT

With your Westie i would go straight to 2%, dose is 1 drop in each eye twice a day. Sign off license informed consent etc.

There is little point putting in more than one drop as it just overflows.

Re: Diluting Sandimmun - help!

Stephen Courtney — Sat, 17 Nov 2012 15:20:15 GMT

We make a 2% solution. It is a real fiddle though, and sometimes i wish we used protopic ointment instead.

Basically you have to carefully snip a split into a 100mg neoral capsule ( 100mg ciclopsporin in an oil base) and aspirate the drug with a syringe and needle, all without getting the stuff on your fingers ( wear gloves) or stabbing yourself. Put the contents into a brown glass dropper bottle. Do it again with another capsule. then add 9ml of corn oil (Mazola is fine) , put the dropper lid in place screw it down and give it a good shake. Voila.

We used to use olive oil, but it seems to sting more, and also goes quite brown/ oxidises quickly. some folk say the bottle should be thrown away after 4 weeks. I don't bother worry, let the client finish the bottle. a diplomate ophtho said that would be fine, and so far after several years of no problems, i would agree. try to train them to give several days notice for a refill as it is a real hassle doing it in a hurry in the middle of evening surgery because some tit is in a hurry

Re: Diluting Sandimmun - help!

Iain McAllister — Sat, 17 Nov 2012 13:18:31 GMT

Thinking about putting a refractory dog on this - do people usually go 0.5% first or jump to 1% or even 2%?

- dog is difficult altho not as difficult as the owner so I would like to get the best result!

- also what dose do you use - it's a WHWT - so 1 drop for an eye of that size or 2? plus frequency bid or tid

thanks

Re: Diluting Sandimmun - help!

Rob Loxley — Sun, 10 Jan 2010 11:38:50 GMT

On another tack, you could phone Moorefield's: they'll happily provide cyclosporin in an ophthalmic preparation in whatever strength you require, manufactured in an aseptic way, in regulated and inspected lab conditions.
They also have 0.2% 3.5g tubes on the shelf if you're experiencing Optimmune supply issues.

Re: Diluting Sandimmun - help!

Emma Middleton — Sun, 26 Jul 2009 16:42:52 GMT

Laurence thank you so much for your reply. That makes it a lot clearer. I'll make up a new crib sheet for the practice!

Regards,

Emma

Re: Diluting Sandimmun - help!

Laurence Webb — Sat, 25 Jul 2009 21:39:49 GMT

A 1% solution is the same as 1g/100ml=1000mg/100ml=100mg/10ml

Therefore a 10ml bottle of a 1% solution contains 100mg ciclosporin

Sandimmune injection is 50ml/ml therefore you need to mix 2ml Sandimmune with 8ml corn oil (or 1ml Samdimmune with 4ml corn oil) to get your desired concentration.

nb you don't mix 2ml Sandimmune with 10ml corn oil as that would make up a total volume of 12ml giving you a dilution of 100mg/12ml=0.8333%.

If you can't be bothered to work out the other concentrations they are...

0.5% - 1ml Sandimmune in 9ml corn oil

1% - 2ml Sandimmune in 8ml corn oil OR 1ml Sandimmune in 4ml Corn oil

2% - 4ml Sandimmune in 6ml corn oil OR 2ml Sandimmune in 3ml corn oil OR 1ml Sanimmune in 1.5ml corn oil